MEDICARE: COMMUNITY COUNSELING AND CRISIS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0061	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000005073	OTHER	OH	ANTHEM BC/BS
2	185955000	OTHER	OH	MAGELLAN BEHAVIORAL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760431589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY COUNSELING AND CRISIS CENTER

Provider Business Mailing Address
First Line	:	110 S COLLEGE AVE
Second Line	:
City	:	OXFORD
State	:	OH
Zip	:	45056-1738
Country	:	US
Telephone Number	:	513-523-4149
Fax Number	:	513-523-4145

Provider Business Practice Location Address
First Line	:	110 S COLLEGE AVE
Second Line	:
City	:	OXFORD
State	:	OH
Zip	:	45056-1738
Country	:	US
Telephone Number	:	513-523-4149
Fax Number	:	513-523-4145

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. CAROLYN BARKER
Credential	:
Telephone Number	:	513-523-4149

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	09/23/2011

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